Lung cancer screening in septuagenarians: Do survival benefits persist with advancing age?

Abstract

e20095 Background: Low-dose CT (LDCT) for lung cancer screening (LCS) reduces lung-cancer-specific mortality in high-risk individuals and is recommended by the United States Preventive Services Task Force for adults 50-80 with significant smoking history. That said, clinical trials informing these recommendations did not enroll patients ≥75. We evaluated whether screening outcomes and survival benefits persist in older adults with high-risk screening findings. Methods: We conducted a retrospective cohort study of patients undergoing LDCT screening at a single institution between January 2019 and July 2023. Patients with Lung-RADS (Lung Imaging Reporting and Data System) category 4 findings were included. Demographics, comorbidities, staging data, procedural details, and outcome data were extracted from the health record. Biopsy and surgical complications were analyzed separately; the former including pneumothorax (PTX) and hemoptysis, and the latter including PTX, prolonged air leak, pneumonia, acute respiratory distress syndrome (ARDS), dysrhythmia, and surgical site infection. Patients were stratified by age: 65–69 (Cohort A), 70–74 (Cohort B), and ≥75 years (Cohort C). Outcomes were analyzed in RStudio (coding utilizing AI-assistance with human oversight) using regression modeling, Kaplan–Meier survival analysis, and Cox proportional hazards. Results: Among 25,571 screening examinations, 252 patients aged ≥65 with Lung-RADS 4 findings were identified: Cohort A (n = 118), Cohort B (n = 90), and Cohort C (n = 44). Demographics, comorbidities, smoking history, Lung-RADS subcategories, biopsy rates, and resection rates were similar across cohorts. Biopsy-related complications did not significantly differ by age, though patients ≥75 had higher post-resection complication rates (RR 3.19, 95% CI 1.47-6.94; p = 0.018). Overall survival (OS) at the time of administrative censoring (6.85 years from screening) differed significantly by age, with worse OS in patients ≥75 years (HR 2.43, 95% CI 1.39–4.23; p = 0.002). Lung cancer–specific survival (LCSS) and recurrence-free survival (RFS) did not differ significantly between groups (Table 1). Conclusions: Adults ≥75 undergoing LDCT for LCS with high-risk findings demonstrate LCSS and RFS similar to those of younger cohorts, despite higher postoperative complication rates and worse OS. These findings suggest that LDCT screening benefits persist in older adults and supports continued inclusion of select patients ≥75 in lung cancer screening programs, with careful consideration of surgical risk. Survival comparison using cox proportional hazards regression. Outcome Hazard Ratio (Cohort C vs A) p-value (C vs A) Hazard Ratio (Cohort C vs B) p-value (C vs B) Global p-value OS 2.43 (1.39 – 4.23) 0.002 1.84 (1.04 – 3.25) 0.037 0.012 LCSS 1.66 (0.57 – 4.82) 0.348 0.98 (0.35 – 2.76) 0.966 0.380 RFS 0.73 (0.15 – 3.47) 0.691 0.82 (0.16 – 4.08) 0.809 0.916